{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:30:54Z","timestamp":1753878654002,"version":"3.41.2"},"reference-count":32,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T00:00:00Z","timestamp":1738195200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Data on Escalation Therapy versus Early Intensive Therapy (EIT) Strategy in multiple sclerosis (MS) are lacking, particularly in Afro\u2010Caribbean cases, known for their severity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To assess efficacy and safety of these strategies in a predominantly Afro\u2010Caribbean relapsing\u2013remitting MS population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A multicenter retrospective study of 195 MS patients, including 66 on EIT, with \u22652\u2009years follow\u2010up. Primary outcome: Kaplan\u2013Meier curves and log\u2010rank test were used to assess irreversible progression to EDSS scores of 3, 6, and 8. Secondary outcomes: change in EDSS score, risk factors for EDSS progression, and severe adverse effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>EIT showed slower EDSS 3 progression than Escalation (median survival 13.5 vs. 9.8\u2009years, <jats:italic>p<\/jats:italic>\u2009=\u20090.024). After a median follow\u2010up of 8\u2009years, 89.5% on EIT remained free from EDSS 3 versus 63.8% on Escalation. Univariate analysis linked Escalation (hazard ratio (HR; 95% CI): 2.42 [1.09\u20135.34]), age at first relapse (HR: 1.04 [1.01\u20131.06]), incomplete symptom regression (HR: 1.69 [1.02\u20132.77]), and EDSS 3 progression. EDSS stabilized or decreased with EIT but worsened with Escalation (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Safety profiles were similar.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>EIT extends median time to irreversible EDSS 3 in Afro\u2010Caribbean individuals compared to Escalation, supporting its preference as initial treatment.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.70030","type":"journal-article","created":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T06:00:16Z","timestamp":1738303216000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early intensive therapy versus escalation strategy in French Caribbean multiple sclerosis cohort"],"prefix":"10.1111","volume":"32","author":[{"given":"Thomas","family":"David","sequence":"first","affiliation":[{"name":"Department of Neurology University Hospital of Guadeloupe  Pointe\u2010\u00e0\u2010Pitre\/Abymes Guadeloupe France"},{"name":"Faculty of Medicine University of the Antilles  Pointe\u2010\u00e0\u2010Pitre 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